| What are “controllers”? |
Controllers are anti-inflammatory medicines that prevent asthma attacks from starting. Controllers reduce the inflammation in the airways that causes them to be “hyper-responsive”, and become narrower.
The most effective and most used controller medicines are inhaled glucocorticosteroids such as budesonide, beclomethasone and fluticasone.
Inhaled glucocorticosteroid medications have preventive effects and should be taken every day.
Airway openers (bronchodilators) are also usually used as controllers, and can also have a preventive effect. Both long- and short-acting bronchodilators can, however, only prevent asthma symptoms for some hours and do not treat the underlying inflammation. This type of medication should therefore not be used regularly without an anti-inflammatory medicine every day as well.
Long-acting bronchodilators are being used more and more in combination with inhaled glucocorticosteroids for preventing asthma. |
| What are “relievers”? | Relievers – or airway openers - are medicines that give quick relief. They act by relaxing the small muscles in the airways, thereby opening (“dilating”) them. Such medicines are often called bronchodilators.
There are two types of airway openers; short-acting bronchodilators and long-acting bronchodilators. The most widely used short-acting bronchodilators are salbutamol/albutamol and terbutalin. Long-acting bronchodilators also give quick relief.
One long-acting bronchodilator, formoterol, has both a rapid onset of action (within 1-3 minutes) and a long duration (more than 12 hours). |
| What are combination medications? |
Combination medications – reliever (airway opener) and controller (anti-inflammatory) in the same inhaler – have two important effects. One is that they open up the airways, or even prevent tightening. The other is that they reduce the underlying inflammation that causes asthma.
These combination inhalers improve symptom control whilst reducing the number of inhalers you have to use.
Some combination medications rely on a fixed dosage, which means that the amount of medication you take is the same. But since the level of your asthma changes over time, it means that sometimes you’ll be taking a bit more medication than you really need, and during your more severe periods you won’t be getting enough and may have to compensate with an airway opener anyway.
Recently, however, a new type of medicine has been developed that prevents inflammation AND opens up the airways AND lets you safely adjust the dosage to match the changes in your asthma.
This medication makes it possible for you to take the right level of medication at the right time, even though less medication is used. |
| What effects do anti-inflammatory medications have? | Anti-inflammatory medications (controllers) work against the inflammation in the airways, the “origin” and underlying cause of asthma symptoms and attacks - in contrast to the airway-opening acute medications that affect only the tightening (contraction) of the muscles of the breathing tubes.
The inflammation and its effects are reduced and often nearly eliminated. The swelling of the airways goes down and is prevented, the narrowing due to muscle tightening is prevented, and over-sensitiviness in the airways is reduced.
The use of anti-inflammatory medications has revolutionized asthma treatment. It is very effective and can control asthma in most people.
The by far most effective anti-inflammatory medicines are inhaled glucocorticosteriods, e.g. budesonide. |
| What effects do airway opener medications have? | Airway opener medications are sometimes called relievers or bronchodilators. These medications, which are used to relieve symptoms, work by relaxing the tightened (contracted) muscles of the airways. This makes it easier to get air in and out of the lungs.
Medications of this type work quickly and can be used to treat an asthma attack. They are sometimes called short-acting or "rescue" bronchodilators. |
| What is a glucocorticosteriod? |
Glucocorticosteriod is the chemical name for a group of corticosteroids, also known as hormones (and also produced in the body).
One of these is cortisone, which is produced in the adrenal gland, but “cortisone” is often used for the whole group of substances. Cortisone has anti–inflammatory effects, which are very desirable in the treatment of asthma.
When using the term glucocorticosteriods here, we always refer to the inhaled corticosteroids that have the same positive effects as cortisone but with no or much fewer side-effects. |
| Why should glucocorticosteriod medications be inhaled? |
Glucocorticosteriods are mainly taken by inhaling, which gives the anti-inflammatory benefits on the mucus membrane in the airways but avoids the harmful effects on the rest of the body.
The small part of the medication that goes into the bloodstream rapidly vanishes from the body, so there are normally none of the usual side-effects of other types of cortisone treatment.
The inhaled corticosteroid budesonide is even approved for use by pregnant women. |
| What are inhaled corticosteroids? |
The corticosteroids used for inhalation are effective anti-inflammatory medications and are therefore the basic treatment for most people with asthma.
Thanks to inhaled corticosteroids, most people with asthma no longer need to take cortisone tablets and thus they avoid the problems that often come from cortisone in tablet form |
| When and why are cortisone tablets to be used? |
Cortisone tablets or injections may be used to further reduce inflammation of the airways and thus treat and prevent attacks – if inhaled corticosteroids have not had enough effect or haven’t been available.
Short-term usage of oral or injected cortisone during a moderate to severe attack is helpful.
Single injections and short treatments with tablets have few side-effects. High doses can temporarily affect your mood, both positively and negatively. Long-term treatment can cause several side-effects, including osteoporosis, thinning of the skin, weight gain, high blood pressure and high blood-sugar levels |
| What is the difference between a corticosteroid and an anabolic steroid? | | Both are sometimes called “steroids”. However, the corticosteroids used in preventive asthma medication are very different from anabolic steroids. Corticosteroids reduce the swelling in the airways that make breathing difficult and also reduce the amount of mucus produced by the body. Anabolic steroids are artificial versions of the male hormone testosterone and are illegally used by some athletes to increase lean muscle mass, strength and endurance. |
| What are anti-inflammatory non-steroidal inhalers? | | These are non-steriod anti-inflammatory medications, for example cromones (disodium cromoglycate and nedocromil). They have weaker anti-inflammatory effects than corticosteroids. If your doctor gives you one of these medications you must take it regularly even if you are not wheezing. If you have an asthma attack while you are on these medications, you must take an airway opener medication to treat the attack. |
| Is there an effective alternative to using inhaled corticosteroids? |
There are no alternatives that control asthma as effectively as inhaled corticosteroids.
The inhalation of cromones is less effective and their anti-inflammatory effects are only partial.
The use of anti-leukotrienes as an alternative to inhaled corticosteroids, but as controlling and preventing medication has not been proven effective they are not recommended as the only drug for controlling asthma.
Regular use of bronchodilators such as theophylline instead of inhaled corticosteroids is no alternative because these medications do not deal with the underlying inflammation, which is then allowed to become worse over time.
You can discuss alternatives with your doctor. |
| What are anti-leukotrienes? |
Anti-leukotrienes are a new class of anti-asthma medication. They work only against the part of the inflammation caused by chemical substances called leukotrienes.
They have some anti-inflammatory effect and some protective effect against bronchoconstriction. But they are not recommended as the only drug for controlling asthma.
They are taken in tablet form once a day. |
| Do I still need my inhaled corticosteroid if I feel OK? | Yes. Asthma is a long-term (chronic) disease that causes inflammation and tightening of the airways. Asthma is not a fixed state, but changes over time, and some degree of chronic inflammation may always be present, even when you are unaware of any symptoms.
Many people with asthma sometimes forget or choose not to take their anti-inflammatory medication, especially during periods when they are feeling well. When they start to feel their asthma, they try to make up for this by increasing the doses of airway openers (bronchodilators). This will not, however, treat the underlying inflammation and may lead to severe attacks. |
| Inhaled corticosteroids are recommended for treating asthma because they are anti-inflammatory. Aspirin is anti-inflammatory, but is not recommended for people with asthma. Why? | | Cortisone and aspirin are both anti-inflammatory, but with different modes of action. Cortisone acts on many types of inflammation, while aspirin works on one specific enzyme – one that is not related to asthmatic inflammation. |
| When a person with asthma needs an anti-inflammatory medication to relieve inflammation due to a strained muscle, aching joints, severe back pain, rheumatism etc, what should he take? | | If a person has been using aspirin or its relatives (called NSAIDs) without any asthma problems, he or she may continue using them. If he or she is uncertain or has had symptoms from those drugs, it would be better to use paracetamol or a similar drug. |
| What is hyposensitisation (vaccination)? |
“Hyposensitisation”, also called “allergy vaccination”, is a treatment that gives increasing oral or injected doses of the very allergen or allergens that cause the asthma. The idea is that the body will learn to defend itself against these allergens and no longer develop allergy reactions.
The method has been used for more than 80 years and is still the only treatment that can reduce a specific allergic reaction. The method works for asthma that has been provoked by pollen, furry animals and dust mites, but not for mould.
The more allergen-specific your asthma is, the better the chances are for a good result with hyposensitisation. But an asthmatic that reacts to “everything” will not get better from this type of therapy.
This treatment may involve risks for systemic allergic reactions and should only be conducted by a specialist.
The treatment is rather expensive and is not available in all countries. |
| I'm troubled by my asthma when outdoors in cold weather. What can I do? |
First of all, be sure that you have an effective anti-inflammatory treatment. If cold air causes asthma symptoms, inhaled corticosteroids are probably needed. If you are already taking them, ask your doctor whether to increase the dose or give additional treatment. A long-acting bronchodilator such as formoterol may be the best choice.
The reason cold air causes asthma symptoms is that cold air dries and irritates the mucus membranes in the airways, especially in people with asthma.
An alternative or complement to medicine can be a face mask that helps to heat and moisturise the inhaled air. Ask your doctor or at the pharmacy. |
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